An extreme means of protest emerges in brutal conditions.

Venezuela may have the worst prisons in Latin America. The country's 30 or so facilities were built for 12,000 inmates, but hold nearly four times that many. In many institutions, guards have surrendered control to armed gangs headed by prisoner-tyrants called pranes. Inmates exchange drugs and weapons openly. Riots occur frequently. In 2011, there were more than 500 violent deaths in the country's penitentiaries.

[Leo Ramírez] At the lowest end of the prison power structure are los anegados -- the unwanted ones -- prisoners who have angered the pranes or allies of the pranes, on the inside or outside, and fear for their lives. And so, in an act of desperation, they stitch their mouths shut. Within the country's prisons there is an unspoken, but religiously followed, agreement among inmates: When one sews his lips, no one can kill him.

Journalist Leo Ramírez, 25, entered the prison of El Rodeo, just outside Caracas, in 2010. "I entered the prison as a Venezuelan, not as a photographer," he said. "I felt it was necessary to go in and see if everything that had been said was true."

Accompanied by a former inmate, Ramírez went deeper and deeper into the prison, until he saw an isolated group of men leaning against a wall. "They had ice on their mouths to alleviate the pain," he said. "I asked the former inmate who brought me who they were, and he told me only, 'Don't get near them. They're very angry.'"

Thirty minutes passed. "I couldn't stop thinking about them," said Ramírez. "So I decided to approach them. Obviously, I spoke more than them, since it's painful for them to speak. Little by little, they told me about themselves."

Los anegados use what they can to bind their lips: thread, plastic, shoe strings. And the act speaks not only to the pranes, but also to the government, "They use the macabre, Dante-esque symbol of sewing their mouths to pressure the government to move them to a prison where their lives are not in danger," said Ramírez. "I'm not sure any of them managed to get a transfer."

In 1999, in the earliest days of his presidency, Hugo Chávez vowed to reform the nation's prison system. Instead, the system has worsened. He promised 24 new facilities, but just four have gone up. And as legal reforms caused the prison population to swell, state control diminished on the inside. But the situation, said Ramírez, goes beyond the current administration. "This is a problem that has existed for more than 50 years."

After Chávez's reelection in October, he declared a state of emergency in the prison system, vowing for a complete transformation. Now, with his health uncertain, the country could be looking at a new leader -- and soon. Prison reform, however, looks far away. "The situation is larger than any political change that will happen in Venezuela," said Ramirez.

In late January, authorities entered one of the country's largest penitentiaries, attempting to confiscate weapons. Disaster ensued: two days of gunfights left 61 people dead and more than 100 injured. Ramírez photographed the aftermath.

"As a Venezuelan, and as a photographer, I do these things with the motivation of helping through images," he said. "But little by little, I've realized that this isn't so easy. I feel my work in El Rodeo has helped me more as a photographer than it has changed the prison situation in my country. I won the Pictures of the Year Latin America award for these photos. I had an exhibition that traveled throughout the world. But I see that the situation in Venezuelan prisons is exactly the same. It's something frustrates me quite a bit."